Hospice Training Guide

MANAGING SYMPTOMS

Bleeding

Bowel & Bladder Issues

Anticoagulants (blood thinners) such as Coumadin (warfarin), heparin, aspirin, clopidogrel (Plavix), Eliquis apixaban), Xarelto (rivaroxaban), and Pradaxa (dabigatran) keep your blood from clotting. These drugs may prevent blood clots such as deep vein thrombosis, stroke, or pulmonary embolism. If your physician has prescribed an anticoagulant, it is important for you to know how to stay safe, what foods can inter- fere with the effectiveness of the medication, and be aware of possible side effects. Safety Tips while on Anticoagulant (Blood Thinner) Inside the Home:

Changes in bowel or bladder habits are a result of many things like inactivity, change in eating habits, medi- cation, and lack of privacy.

Constipation Constipation is a longer-than-normal period between regular bowel movements or unusually hard stool. A patient should have a bowel movement at least every 3 days, even if not eating very much. To help, follow these suggestions: • Have the patient drink water and fluids as much as possible. • Walk daily if possible. • Eat foods high in fiber, such a vegetables and fruits. • Only use fiber laxatives, like Metamucil, if the pa- tient can drink several glasses of fluids each day. • Vegetable laxatives and stool softeners, such as senna and docusate, are preferred, especially if the patient is taking pain medications. Diarrhea Diarrhea is frequent, watery stools that may be ac- companied by stomach cramping. To help, follow these suggestions: • Have the patient drink liquids such as water, ap- ple juice, non-caffeine sodas, or chicken broth until the symptoms end. • Avoid dairy products such as milk, cheese, or ice cream. • Gradually offer the BRAT diet (bananas, rice, ap- plesauce, toast) as the diarrhea begins to stop.

Incontinence Many patients become incontinent and/or cannot control emptying their bladder. Some have diffi- culty fully emptying their bladder and may become

uncomfortable or restless as the bladder distends. Here are some tips for managing in- continence: • Use waterproof pads or adult briefs to protect clothing and furniture. • Keep the patient’s skin clean and dry often to avoid skin irritations or breakdown. • Sometimes a catheter (a

• Use an electric razor. • Use a soft toothbrush. • Do not use toothpicks. • Take extra care trimming toenails (your nurse can assist with nails). • Do not trim corns or calluses. • Be very careful using knives and scissors.

• Wear shoes or non-skid slippers at all times. • Follow fall prevention suggestions. • Tell your nurse about all the medications you are taking. Some medications interact with blood thin- ners.

• The patient may wear a medical information tag, such as a Medic Alert bracelet, to alert others of the anticoagulants. Safety Tips while on Anticoagulant (Blood Thinner) Outside the Home: • Always wear shoes to help prevent falls. • Wear heavy gloves when working outside or with tools. • Avoid activities and sports that can cause injury,, especially cuts or bruising. • Be very careful with sharp tools. Possible Side Effects of Anticoagulants (Blood Thinners):

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thin, soft tube) is inserted into the bladder to drain urine. Your nurse can do this if it becomes best for the patient. For All Bowel or Bladder Issues: • Allow for privacy, with doors closed, curtains pulled, or privacy screens. • Stay close by for the patient’s safety, in case they need assistance. • Use a bedside commode, bedpan, or urinal if walk- ing to the bathroom is not safe or too difficult. Your Care Team can arrange for this equipment. • Sitting upright, gently rocking back and forth, is more comfortable than straining.

• Most side effects relate to how the medicine works. In preventing clotting, blood thinners can make bruising and bleeding more common. • When taking medicines such as warfarin, blood may be tested routinely so the amount of medi- cation can be adjusted to lower the risk of exces- sive bleeding.

• Minor bleeding may occur even when the medi- cine is working properly. For example, you may notice small bruises or slight gum bleeding when you brush your teeth.

CALL YOUR CARE TEAM IF: • Patient has not urinated or emptied bladder for 12-18 hours. • Patient experiences abdominal pain or burning when urinating or when emptying bowels. • Patient’s abdomen becomes hard, or swollen. • Patient’s urine is discolored, dark, or contains blood. • Patient is unable to control urination. • Patient does not have a bowel movement in 3 days, even with very little or no eating. • Patient has 2-3 episodes of diarrhea within an 8-hour period.

CALL YOUR CARE TEAM IF:

• Patient has bleeding from cuts or scrapes that do not stop after apply- ing gentle pressure for 20 minutes. • Patient has bloody urine.

• There are any falls. • There is increased bleeding from nose or gums. • Patient has bloody or tar-like stools, or stools that look like coffee grounds.

866.466.9734 • FourSeasonsCare.org

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